scholarly journals 146 Improving Outcomes in Aspiration Pneumonia: A Collaborative Approach

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
S Richards-Taylor ◽  
R Kitchener ◽  
M Whiffen ◽  
D Tiwari
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Aspiration Pneumonia ◽  
Clinical Care ◽  
Collaborative Approach ◽  
Bed Elevation ◽  
Pdsa Cycle ◽  
Mouth Care ◽  
Referral Form ◽  
Expected Mortality

Abstract Introduction Aspiration pneumonia is a major cause of morbidity and mortality especially in older adults. Our Trust recorded higher than expected mortality ratios in this group of patients. Aim To investigate reasons behind higher than expected mortality and improve outcomes. Intervention We developed a collaborative approach of investigating mortality in aspiration pneumonia with joint input from Speech and Language (SALT) specialists. Method We conducted structured retrospective review of annual mortality in aspiration pneumonia in 3 PDSA (plan, do, study, and act) cycles in 2015/18/20. We collected data on clinical care, diagnostic accuracy, SALT referral/input, feeding at risk discussion, communication with primary care. We monitored mortality ratios on national systems. Results We improved clinical and nursing care by auditing mouth care, bed elevation and safe feeding. We also developed electronic-SALT referral form to improve timings for the reviews (first PDSA cycle). SALT team developed “feeding at risk proforma” to formalise risk feeding where safe swallow plan was not possible (second PDSA cycle). We modified discharge summaries and made this a multidisciplinary document in the Trust so that SALT can communicate feeding plans to primary care (third PDSA cycle). Mortality ratios improved significantly in this period from Relative risk of 152 (higher than expected range) in 14/15 to 86 (within expected range) in 19/20. Conclusion We have demonstrated significant improvement in hospital mortality ratios from aspiration pneumonia and therefore improved care by collaboratively working with SALT team and bringing changes in stepwise manner. Multidisciplinary mortality reviews are key to improving outcomes for our patients.

A Collaborative Approach to Health Promotion Targeting People with Mental Illness at Risk of Diabetes—A Process Evaluation

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2261-PUB
Author(s):  
NANA F. HEMPLER ◽  
VINIE H. LEVISEN ◽  
REGITZE S. PALS ◽  
NAJA RAMSKOV KROGH ◽  
RIKKE H. LAURSEN
Keyword(s):  
At Risk ◽  
Health Promotion ◽  
Mental Illness ◽  
Process Evaluation ◽  
Collaborative Approach ◽  
People With Mental Illness

At Risk Drinking in Primary Care: report from a survey in Sao Paulo, Brazil

Addiction ◽  
1989 ◽  
Vol 84 (6) ◽  
pp. 653-658 ◽  
Author(s):  
EDUARDO IACOPONI ◽  
RONALDO RAMOS LARANJEIRA ◽  
MIGUEL ROBERTO JORGE
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Sao Paulo ◽  
São Paulo

Adolescent Depression Screening in Primary Care: Who is Screened and who is at Risk?

2021 ◽  
Author(s):  
Molly Davis ◽  
Jason D. Jones ◽  
Amy So ◽  
Tami D. Benton ◽  
Rhonda C. Boyd ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Adolescent Depression ◽  
Depression Screening

Chronic Cough in Children: A Primary Care and Subspecialty Collaborative Approach

2013 ◽  
Vol 34 (11) ◽  
pp. 498-509
Author(s):  
Robert Kaslovsky ◽  
Matthew Sadof
Keyword(s):  
Primary Care ◽  
Chronic Cough ◽  
Collaborative Approach

scholarly journals Datasets collected in general practice: an international comparison using the example of obesity

2018 ◽  
Vol 42 (5) ◽  
pp. 563 ◽  
Author(s):  
Elizabeth Sturgiss ◽  
Kees van Boven
Keyword(s):  
Primary Care ◽  
General Practice ◽  
The Netherlands ◽  
Care Management ◽  
Clinical Care ◽  
International Comparisons ◽  
Health Condition ◽  
Practice Management ◽  
Number Of Patients ◽  
Primary Care Management

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A131-A136 ◽  
Author(s):  
Ian R. H. Falloon
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Early Detection ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Signs And Symptoms ◽  
Psychotic Episode

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

scholarly journals Early intervention for children at risk of visual processing dysfunctions from 1 year of age: a randomized controlled trial protocol

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marlou J. G. Kooiker ◽  
Yoni van der Linden ◽  
Jenneke van Dijk ◽  
Ymie J. van der Zee ◽  
Renate M. C. Swarte ◽  
...  
Keyword(s):  
At Risk ◽  
Randomized Controlled Trial ◽  
Visual Processing ◽  
Intervention Program ◽  
Controlled Trial ◽  
Clinical Care ◽  
Control Group ◽  
Randomized Controlled ◽  
Extremely Preterm ◽  
Intervention Protocol

Abstract Background An increasing number of children are suffering from brain damage-related visual processing dysfunctions (VPD). There is currently a lack of evidence-based intervention methods that can be used early in development. We developed a visual intervention protocol suitable from 1 year of age. The protocol is structured, comprehensive and individually adaptive, and is paired with quantitative outcome assessments. Our aim is to investigate the effectiveness of this first visual intervention program for young children with (a risk of) VPD. Methods This is a single-blind, placebo-controlled trial that is embedded within standard clinical care. The study population consists of 100 children born very or extremely preterm (< 30 weeks) at 1 year of corrected age (CA), of whom 50% are expected to have VPD. First, children undergo a visual screening at 1 year CA. If they are classified as being at risk of VPD, they are referred to standard care, which involves an ophthalmic and visual function assessment and a (newly developed) visual intervention program. This program consists of a general protocol (standardized and similar for all children) and a supplement protocol (adapted to the specific needs of the child). Children are randomly allocated to an intervention group (starting upon inclusion at 1 year CA) or a control group (postponed: starting at 2 years CA). The control group will receive a placebo treatment. The effectiveness of early visual intervention will be examined with follow-up visual and neurocognitive assessments after 1 year (upon completion of the direct intervention) and after 2 years (upon completion of the postponed intervention). Discussion Through this randomized controlled trial we will establish the effectiveness of a new and early visual intervention program. Combining a general and supplement protocol enables both structured comparisons between participants and groups, and custom habilitation that is tailored to a child’s specific needs. The design ensures that all included children will benefit from participation by advancing the age at which they start receiving an intervention. We expect results to be applicable to the overall population of children with (a risk of) VPD early in life. Trial registration Netherlands Trial Register: NTR6952. Registered 19 January 2018.

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